Physician field response: a national survey.
OBJECTIVE: To assess the availability, scope of practice, and training of physician field response (PFR) units for emergency medical services (EMS) systems in the United States. METHODS: The physician medical directors of EMS systems in the 125 most populous U.S. cities were surveyed by mail, with a second mailing and phone follow-up to nonresponders. In cities that listed multiple services, a survey was sent to each. RESULTS: One hundred sixty-eight surveys were mailed, and 121 responses were received (72%), representing 109 of the 125 cities (87%). Seventy-seven cities (71%) reported having no PFR capability. Of the 32 (29%) with some type of PFR, two reported having a dedicated field response unit, while 30 had an "on-call" system from the hospital or home. Staffing patterns were highly variable, with no dominant pattern. The number of annual PFR responses ranged from 0 to 10,000 (median 15, IQR 3-200). All systems reported that their PFR unit was well accepted by EMS providers. The following scope-of-practice items were reported (n = 30): physician triage, 30 teams (94%); on-scene medical direction, 14 (47%); amputation, six (20%); tube thoracostomy, 12 (40%); and blood administration, 29 (97%). The following training requirements for physician team members were reported (n = 32): incident command system, 15 (47%); emergency vehicle operations, 12 (38%); hazardous materials, 13 (41%); vehicle rescue/extrication, seven (22%); confined space medicine, four (13%); and none 12 (38%). CONCLUSION: There is a wide variability in the availability, training, and scope of practice of PFR units across the country. No standardization or trends could be detected.